Diagnosing the digital doctor

While the US ties itself in knots over the politically divisive topic of 'Obamacare', in Europe there's a productive debate underway about the future of the healthcare industry in a digital economy.

Healthcare and IT haven't always been easy bedfellows. In the UK, the abortive NHS National Programme for IT (NPfIT) stands as a beacon of failure and appalling waste of billions of pounds of public money in a futile and badly-managed pitch for a spurious modernity.

NPfIT set out to create electronic patient care records across the entire NHS and its affiliate agencies, right down to general practitioner level. From the get go - when it was commissioned in less than an hour by the then Prime Minister Tony Blair - through to its painful dying days over ten years later, the programme was attacked by legislators in the UK government, defended by suppliers who took home millions of pounds but seemingly delivered very little and criticised by the healthcare industry which had been frozen out of any requirements specification.

It was, in short, a text book example of how not to do a public sector IT project.

Digital health 

But an IT-enabled healthcare system ought to be a de facto part of a digital nation. The European Commission has turned its attention to this topic of late, most notably at the Ministerial eHealth High Level Conference in Dublin this week where the idea of eHealth ecosystems was on the agenda.

eHealth ecosystems pool the resources of health and social care providers, industry, research institutions, authorities and end users throughout Europe to accelerate the development and adoption of innovative solutions such as eHealth to specific problems in health and social care.

At the conference, ministers from European Union member states agreed that the aims of eHealth ecosystems could be achieved by:

• Strengthening coordination of all policies related to eHealth, from support to research and deployment, to developing a legal framework in specific areas like medical devices, patient safety, information security and interoperability.
• Promoting mutual learning and sharing of good experiences inside ecosystems between purchasers and providers, academia, citizens, industry and throughout the public and private sector health industry.
• Allowing innovative concepts, products and services to create new markets by applying new sets of rules, values and models, and
• Accelerating the implementation of existing and proven devices and processes through intensive innovation techniques and innovative procurement tools to ensure that citizens receive the benefits in a shorter timeframe, by delivering on existing priorities.

Neelie Kroes, Vice-President of the European Commission responsible for the Digital Agenda, is a keen advocate of exploiting the potential of digital health initiatives:

"Our healthcare model is under pressure, in a world where there's more chronic and degenerative conditions. And yet those same health systems, like so much else at the moment, face up to a lack of resources. There's a huge potential in eHealth: to help people stay active and independent for longer, to offer better public services at less cost, but also to stimulate a strong EU market that could serve our citizens – and compete globally."

The EC has put some interesting planks in place to support those ambitions:

• The Commission's eHealth Action Plan was adopted in December 2011 and sets out a roadmap to 2020. 
• Work is underway on interoperability policies and standard to ensure eHealth tools and services work together within and between regions?
• The Horizon 2020 programme is intended to support ICT-enabled innovation, on new health tools, treatments and systems centred on users.
• Deployment of eHealth initiatives can tap into funding such as the Competitiveness and Innovation Programme and the European Regional Development Fund.
• Programmes to improve digital skills and health literacy
• The Commission is also working on a Green Paper to launch a public debate in the area of mobile apps for mobile health and wellbeing. 
• The Commission is currently negotiating proposals for eHealth funding under EU research Framework Programme 7.
• From next month, it will be evaluating eHealth proposals under the Competitiveness and Innovation Programme.

Repeat prescription

So, a lot going on and more to come. Kroes says:

"That's not the whole story. Often, the right instruments lie in other hands: from Finance Ministers to regional governments; researchers to carers; insurers and venture capitalists to digital entrepreneurs."

The potential is there for digital revolution in healthcare according to a study from Accenture which polled 3,700 doctors in eight countries. It concludes that doctors are going digital across all countries surveyed (Australia, Canada, England, France, Germany, Singapore, Spain and the United States).

Key findings in the Digital Doctor Is In study:

• 91% of physicians surveyed report that they are active users of electronic medical records (EMR) either in their own practice or hospital/clinic. 
• More than half of doctors surveyed (60%) report using an EMR in their own medical practice. 
• 47% of respondents have electronic access to clinical data about a patient who has been seen by another healthcare organisation.
• Some 66% of respondents now electronically enter patient notes during or after consultations.
• The US showed the largest increase in the number of doctors electronically entering patient notes, up 38% year on year to hit 78% of respondents.

Source: Accenture

The Accenture study observes:

The trend toward IT-enabled healthcare is expected to continue, as doctors continue to go digital. And as the adoption and usage of EMR and HIE continues to rise, there will be greater penetration of electronic health records. Globally, eight out of ten physicians agree that they are committed to promoting electronic health records in their clinical practices—because they believe in it. Nearly three-quarters (74%) of physicians surveyed agree that electronic health records are integral to effective patient care today and globally, eight out of ten physicians agree that electronic health records will become integral to effective patient care in the next two years.

If Accenture's findings are correct, then there is a clear appetite among the healthcare professional community to explore a digital future.

One of the biggest mistakes made by the UK's NPfIT programme was the almost complete exclusion of medical professionals in the scoping and design of the systems.

Classic mistake number one: don't bother asking the people who're going to have to use the system what they want; just build the thing. What could possibly go wrong? A potential £12.7 billion bill for the taxpayer, that's what.

The EC's consultative approach appears a sensible method of moving forward. Inevitably the Commission will be excessively enthusiastic about finding a common approach and trying to set standards across multiple healthcare systems across the European Union.

Obsessing on conformity will be unhealthy and almost certainly lead to an unsatisfactory prognosis, although ominously Commissioner Borg seems to disagree:

"To reap the full benefits of e-health, we need to create systems which are compatible across the European Union. This is precisely what we are seeking to achieve with the e-health network that brings together all EU member states to co-operate on e-health. The network has already endorsed policy aims to improve the interoperability of ehealth systems. The next step is to agree on specific measures such as the minimum set of data in electronic medical records.”

But what emerges from Dublin this week is an enthusiasm for the concept of digital health which may indicate some symptoms of success. Or as Kroes puts it:

“People are living longer: that's a medical triumph. Now let's use digital tools to transform our health and care systems and ensure our citizens lead healthier, happier lives."